MEDICARE: MRS. ANDREA LYNN NYLAND LCDC-III

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	161816	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1902391154
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ANDREA LYNN NYLAND LCDC-III

Provider Business Mailing Address
First Line	:	1815 W MARKET ST
Second Line	:
City	:	AKRON
State	:	OH
Zip	:	44313-7000
Country	:	US
Telephone Number	:	855-747-4673
Fax Number	:

Provider Business Practice Location Address
First Line	:	1815 W MARKET ST
Second Line	:
City	:	AKRON
State	:	OH
Zip	:	44313-7000
Country	:	US
Telephone Number	:	855-747-4673
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/28/2018
Last Update Date	:	12/29/2023

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